PCM II:

Environmental
Sanitation and Control
Nio Ismael Pastor, MD, PHSAE, DRDM, FPSMID

Scope and sequence

Introduction
Housing sanitation

Food sanitation
Milk sanitation

Water sanitation

Insect control

Waste disposal

Rodent control

Air pollution

Scope and sequence

Introduction
Housing sanitation

Food sanitation
Milk sanitation

Water sanitation

Insect control

Waste disposal

Rodent control

Air pollution

Objectives
Discuss health threats from a unsanitary &
unhygeinic environmental factors
Mention different types of sanitation
Correlate between Sanitation and public
health

INTRODUCTION

ES
Control of all these factors in mans
physical environment which exercise or
may exercise a deleterious effect on his
physical development, health and survival
is the hygienic means of preventing
human contact from the hazards of wastes
to promote health

Environmental health (WHO)

Environmental health comprises those
aspects of human health, including quality
of life, that are determined by physical,
biological, social, and psychosocial factors
in the environment.
It also refers to the theory and practice of
assessing, correcting, controlling, and
preventing those factors in the
environment that can potentially affect
adversely the health of present and future
generations.

Environment
All that which is external to the individual
host. [It] can be divided into physical,
biological, social, and cultural factors,any
or all of which [that] can influence health
status in populations.
Last, J. M. (Ed.). (1995). A Dictionary of Epidemiology(3rd ed.). New York: Oxford University Press

PD 856, The Code of

Sanitation of the Philippines

WATER SUPPLY

FOOD
ESTABLISHMENT

MARKETS AND
ABATTOIRS

PUBLIC LAUNDRY
SCHOOL SANITATION
AND HEALTH
SERVICES
INDUSTRIAL HYGIENE

REST AREAS, BUS

TERMINALS, BUS
STOPS, AND SERVICE
STATIONS

CAMPS AND PICNIC

GROUNDS

DANCING SCHOOLS,
DANCE HALLS AND
NIGHT CLUBS

SEWAGE COLLECTION
AND DISPOSAL,
EXCRETA DISPOSAL
AND DRAINAGE
REFUSE DISPOSAL
NUISANCES AND
OFFENSIVE TRADES
AND OCCUPATIONS
POLLUTION OF THE
ENVIRONMENT
DISPOSAL OF DEAD
PERSONS

MASSAGE CLINICS
AND SAUNA BATH
ESTABLISHMENTS

HOTELS, MOTELS
AND APARTMENTS,
LODGING,
BOARDING, OR
TENEMENT HOUSES,
AND CONDOMINIUMS

PORT, AIRPORT, VESSEL AND AIRCRAFT

SANITATION
VERMIN CONTROL
PUBLIC SWIMMING OR BATHING PLACES
TONSORIAL AND BEAUTY ESTABLISHMENTS

Contributors to the
Environment
Chemical
Air pollutants, toxic wastes, pesticides, VOCs

Biologic
Disease organisms present in food and water
Insect and animal allergens

Physical
Noise, ionizing and non-ionizing radiation

Socioeconomic
Access to safe and sufficient health care

 Safe
Free from harm or risk
Secure from threat of danger, harm, or loss
Zero risk

Risk
Possibility of loss or injury, peril
The chance of loss; the degree of probability of such
loss

Environmental catastrophes
Minamata disease (19531961)
Methyl mercury poisoning

Seveso, Italy (1976)

Leak of toxic gas (TCDD)

Bhopal (1984)
16.5 tons of toxic pesticide released

Chernobyl (1986)
Nuclear reactor accident

Milwaukee incident (1993)

Cryptosporidium in drinking water

Major Air Pollution Episodes

Date

Place

Excess deaths

Dec. 1882

London, England

1000

Dec. 1930

Meuse Valley, Belgium

63

Oct. 1948

Donora, Pennsylvania,
USA

20

Dec. 1952

London, England

4000

Dec. 1962

Osaka, Japan

60

Jan 1963

New York City

200-405

Nov. 1983

New York City

250

Chemicals in the environment

Roughly 70,000 different synthetic
chemicals are on the global market; many
others are emitted as by-products of their
production, use, or disposal
Production of synthetic organic
chemicals (e.g., dyes, plastics,solvents)
has increased from less than 0.15 billion
kilograms (1935) to more than 150 billion
kilograms (1995)

World Production of
Synthetic Organic Chemicals

Commercial Chemicals
Chemicals in commerce (1984)
>1 million lbs/yr12,860
<1 million lbs/yr13,911
Production unknown21,752

Each year ~1,000 new chemicals come on

line
It costs ~ $ 2 million to do a cancer
toxicology screen on each chemical (NTP
guidelines)
The cancer toxicology screen takes ~2
years

Environmental Pathways for

Selected Toxic Agents

Types of pollution
Air pollution release of
chemical particulates into the
atmosphere

Noise pollution roadway

noise, aircraft noise, industrial
noise

Water pollution via surface

run off, leaching to ground
water, liquid spills, waste water
discharges, eutrophication,
littering

Visual pollution overhead

power lines, billboards, strip
mining, open storage trash

Soil contamination chemicals

released by spill or
underground storage tank
discharge
Radioactive contamination
alpha emitters and actinides in
the environment

Light pollution over

illumination
Thermal pollution temperature
change in natural water bodies
Stationary pollution sources:
livestock farms, oil refineries,
metal production factories, PVC
factories

The F-Diagramme
Water supply

Sanitation

Fluids

Hygiene

Fingers
Faeces

Food
Flies

Fields/Flo
ors

Future
Victim

Housing sanitation

Housing and the indoor

environment
Have significant effects on physical,
mental and social health and wellbeing.
Furthermore, an unsafe household can
cause unintentional injuries such as falls,
drowning, poisoning, fires and choking.

Healthy House
Physiologic needs
Psychological needs
Protection from contagion
Protection against accidents

Housing: Physiologic needs

Adequate space
Adequate heat and
ventilation
Temp = 20 to 25
degrees Celsius
Movement = 15 to 25
L/min
Humidity = 50 to
80%

Fire protection: proper

electrical wiring,
refuse disposal, two
exits

Lighting intensity of
illumination vary with
activity like 100 ft
candles for reading
Noise not more than
30 decibels
Water supply = 15 to
20 gallons per capital
per day
Sanitary toilet facility
Protection against
accidents

Housing: Psychological
needs
Privacy
Cleanliness and presence of
convenience
Provision of normal family life
Provision of normal
community life

Protection from contagion &

accidents
Safe water
Toilet
Protection from sewerage contamination
Exclusion of vermin, pests
Fire safety
Free of electrical problems
Free of hazardous vehicle traffic

Water sanitation

Water usage
Fluid for animals
Means of
transportation
Cleansing human
body, objects or
environment

Irrigation
Industry
Waste disposal site
Fire extinguisher
Recreation
Fishing

WatSan
There is the direct impact of consuming contaminated water
this is known as 'waterborne disease' and includes :

Diarrhea , Typhoid, viral hepatitis A, Cholera. dysentery.

Single most important preventive measure against diseases
Mere filtration of water reduces mortality not only of water
borne diseases but mortality from other diseases (MillsReineke Phenomenon)
There are 'water based diseases' and "water-related
vector-borne diseases" in which the aquatic environment
provides an essential habitat for the mosquito vectors and
intermediate snail hosts of parasites that cause human
diseases.

Examination of water
Field survey: assess situation of water
shed
Laboratory analysis for potability of water
Physical: turbidity, color, taste and odor
Chemical: pH, solubility, total solids, chlorides, hardness
and iron
Bacteriologic: most important single test (coliforms =
fecal contamination = 0)
Biological: microorganisms responsible for bad odor and
taste
Radiological: done only for water receiving wastes from
nuclear installations or radioisotope laboratories

Water purification
Household treatment: boiling, filtration,
chemical disinfection, storage
Public water supply:
Basic: coagulation, sedimentation, filtration,
disinfection
Others: aeration, softening, fluoridation

Residual chlorine: 0.1 ppm to cause

bacteriologic safety of water

Well
Major water supply in rural areas
Should be located higher than and at a
distance 100 feet from source of pollution,
Should be constructed only in places with
sandy loam and not in clay or limestone

Distribution of water
Part of the urban water system
Must be adequate and well-maintained to
avoid water contamination and wastage
Pollution and contamination of water
importance of physical, chemical and
bacteriologic qualities of water
Contamination: presence of deleterious
chemicals and microorganisms in water

waste disposal

Excreta and sewage should

not:
Contaminated drinking water, water used
to culture shellfish and marine life, and
water for recreational purpose
Contaminated soil to prevent spread of
intestinal parasites
Be accessible to flies, insects and rodents

Qualities of a good toilet

Sanitary
Simple and easy to construct
Economical and durable
Accessible and acceptable to users
Easy to maintain
Provide protection and privacy

Recommended system of
excreta disposal
Rural area: water sealed, sanitary pit privy
Suburban: septic tank system
Urban: sewerage system separate type

Other types
Cat hole
Straddle trench
Antipolo type
Bored hole
Chemical toilet
Pail system
Overhang latrine
Oxidation pond

Sewerage treatment
processes
Screening or separation of large solids
Sedimentation and anaerobic
decomposition
Aerobic decomposition
Disinfection of effluent

Fixed disposition of the

effluent
Dilution in bodies of water
Land surface or subsurface irrigation

Refuse
Solid or semi-solid other than excreta
Storage in garbage cans with tight cover,
adequate collection in trucks with cover
and proper disposal
Individual dispersal

Burying
Burning
Animal feeding
Composting
Garbage grinding
Dumping on land or water

The
Payatas
Tragedy

A river of garbage

Community disposal of refuse

Sanitary landfill
Incineration
Composting: most common way of
disposal in the Philippines
Dumping

GARBAGE SITUATION IN
THE PHILIPPINES:
A Filipino generates between 0.3 and 0.7 kilograms of
garbage daily depending upon income levels.
NCR and Southern Tagalog Region produce the
highest amount of waste accounting for 23 and 13% of
the countrys production.
70% of garbage is collected in Urban Areas and 40%
in Rural Areas
13% of Metro Manilas waste is recycled.
Nationally, only 2% of waste are disposed in sanitary
landfills or controlled dumps. 10% are composted,
and small portion is recycled. The rest is disposed in
open dumps.

NATIONAL WASTE GENERATION, 2000-2010

2000
National Capital Region
Coldillera AR
Ilocos
Cagayan Valley
Central Luzon
Southern Tagalog
Bicol
Western Visayas
Central Visayas
Eastern Visayas
Western Mindanao
Northern Mindanao
Southern Mindanao
Central Mindanao
ARMM
Caraga
National

2010

Million
Tons/yr.

% of total

Million Tons/yr.

% of total

2.45

23.0

3.14

22.3

0.17
0.50
0.35
0.96
1.42
0.54
0.82
0.74
0.43
0.40
0.37
0.70
0.33
0.26
0.26
10.67

1.6
4.7
3.0
9.0
13.3
5.1
7.7
7.0
4.0
3.8
3.4
6.6
3.1
2.4
2.4
100

0.21
0.63
0.40
1.32
2.11
0.65
1.00
1.01
0.51
0.53
0.47
0.97
0.41
0.31
0.31
14.05

1.5
4.5
2.8
9.4
15
4.6
7.1
7.2
3.6
3.8
3.4
6.9
2.9
2.2
2.2
100

B1 12.15.15

Paper recovery rate = 16%, one of the

lowest in Asia
In Thailand

= 33%

Singapore = 31%
Malaysia

= 28%

$433,000,000 worth of waste paper,

waste plastics, flat-walled metal and silica
imported from 1991-1995

Source: Solid Waste Management Act of 1998 introduced by Sen.

Gregorio Honasan

MAHALIN NATIN
ANG KALIKASAN

Air pollution

Air pollution
Introduction into the atmosphere of
substances injurious to health or actively
harmless substances in such quantities
that they may create a nuisance
General effects:
Damage to health
Irritation of eyes, ears, nose and throat
Damage to plants and animals
Objectionable odor
Reduced visibility which may cause accidents
Damage to buildings, clothing, etc

Sources of air pollution

Motor vehicles
Industries
Power plants
Burning of refuse
Fires and volcanic eruptions
Radioactive explosions

Factors favoring air pollution

High population density
Prevalence of heavy industries
Temperature inversions
Humid, warm, slow-moving air
Mountains around a valley

Factors preventing air

pollution
Minimize production of waste
Remove waste at source by filters and
collectors
Discharge waste into air through high
stacks
Proper zoning in town planning
Build plants in elevated places and / or
extensive water surface

Food sanitation

Agents
Clostridium botulinum, C. perfringens
Staphylococci, Salmonella, Shigella
Campylobacter jejuni, E. coli 0157:H7
Vibrio parahaemolyticus
Hepatitis A, Norwalk virus, Rotavirus
Calicivirus, Listeria monocytogenes
Cryptosporidium, Giardia, Bacillus cereus
Toxoplasma gondii, Cyclospora

Food borne Diseases

Infection

Intoxication

long incubation period

(days)

short incubation period

(minutes - hours)

diarrhea, nausea,
vomiting, abdominal
cramps. Fever often

Vomiting, nausea, double

vision, weakness,
numbness, disorientation

Salmonella,

C. botulinum

Hepatitis A

Staph aureus

Listeria, Giardia

certain fish/ shellfish

Vibrio, Campylobacter
Norwalk virus

Objectives of food sanitation

To assure consumption of safe and
wholesome food (prevention of food borne
infections and food poisoning)
To prevent the sale of food offensive to
purchaser or of inferior quality (prevention
of adulteration)
Prevent food wastage and spoilage

Food technology for food

preservation
Drying and
dehydration

Smoking

Refrigeration at 0 to 4
degrees Celsius

Sugaring

Canning

Cooking, boiling,
sterilization

Pickling or souring

Addition of
preservatives

Radiation

Salting

Essentials of food
establishment sanitation
Healthy food handlers
Adequate food storage and refrigeration
Adequate lighting and ventilation
Adequate clean water
Sanitary toilets
Lavatory facilities
Safety of food and drinks

The Safe Food Handler

Training
Food borne infection
Reporting to public health authorities

Carrier state
during incubation, illness or recovery
asymptomatic chronic shedding
Salmonella typhi (Typhoid Mary)

Personal hygiene

Serving and Holding

Keep hot food above 140 F
Steam tables, keep food covered
Stir foods to ensure even heating

Keep cold food below 40 F

Refrigeration unit/ice

Check temperature periodically

Sanitize thermometer after each use

Discard food held in danger zone (4 hours)

Never add fresh food to food already out for
serving

Serving and Holding

Wash hands before serving food
Clean/sanitary long handled ladles and
spoons for serving
Never touch parts of cups/plates that will
have contact w/food
Cover cuts w/ bandages and cover with
gloves
Change gloves after contact with
contaminated surface

Sanitary Facilities & Equipment

Cleaning & Sanitization
Pest Control
Inspections
clean floors, no debris, clutter, mouse droppings
no food storage on floor
check cleanliness of dishes, utensils in storage
check drawers for debris, cleanliness
check cleanliness of all equipment used in food
preparation or serving (slicers, soup kettles, dispensers

Sanitary Facilities & Equipment

Cleanliness of dishwasher
temperature, detergent, scaling agents
food debris inside machine, grooves on door
washing arms free of obstruction

Backflow prevention devices on plumbing

Mop closets clean, mop head stored upright,
replaced or washed frequently
Facility surfaces and equipment sanitized
and inspected on an ongoing basis

Reheating
Boil/heat to > 165 F within 2 hours of
removal from refrigeration
Never reheat more than once
Never mix leftover and fresh food
Discard leftovers refrigerated for more
than a week from preparation date

Milk sanitation

Essentials of sanitary milk

production
Healthy cows
Clean milking barns
Adequate storage
Pasteurization
Sanitation of milking equipment
Healthy milk handlers
Proper waste disposal

Examination of milk
Physical: total solids and butter fat
Chemical: suspected preservatives added
Bacteriological: plate count, direct
microscopy
Others: reductase test, phosphate test

Ways in which food may be

adulterated
Mixing injurious or other substances to
increase bulk
Concealing inferior quality
Alteration of an essential ingredient
Addition of powdered substances
Selling of partly decomposed products
(eg: double dead meat)
Misbranding or mislabeling

Insect control

B2 12.14.15

Disease may be directly

caused by insects
Hypersensitivity of bites or allergy to hair
or scales
Infestation or direct invasion by mites or
parasitic larva
Indirectly by acting as a vector

Vectors
Arthropods or other invertebrates which
transmit infections by inoculation into or
through the skin or mucus membrane by
biting, or by deposition of infective
materials on skin, or on food or other
objects

Types of vectors
Mechanical: facilitate transmission of
disease agent through attachment to their
body part
Biologic: as biologic vectors the insect
may be the definitive host or intermediate
host of the agent

Control
Transmission of insect-borne diseases
has 3 elements: sick person, vector, well
person
Defensive measures include protective
clothing, repellants, use of nets or
screens, and avoidance of places with
insects.
Offensive or attack measures: directed
towards control of the insect population

Offensive or attack measures

Naturalistic or environmental control:
proper waste disposal, drainage or
flushing of stagnant water, draining,
control of water level
Mechanical: fly paper, swatting
Chemical: larvacides, pesticides
Biologic: release of sterile insects

Rodent control

 Rodents cause harm by serving as

reservoir of infection for plague,
Weils disease, murine typhus, rat
bite fever, salmonellosis, and by
destroying food, clothing and
furniture
Control:
Killing: poisoning, scrapping,
fumigation
Rodent stoppage and rat proofing
Environmental sanitation